Remote Utilization Review Specialist – Behavioral Health

Northpoint-Recovery-Holdings,-LL; Meridian (ID); Remote; USD 41,000 - 48,000; Full time

Benefits offered by this job

Health insurance

Employer paid life insurance

Employee assistance program

Dental & Vision insurance

Short-term disability

Pre-tax savings accounts

Generous paid time off

Job summary

Northpoint Recovery Holdings, LLC is seeking a licensed Utilization Review Specialist to ensure clinically appropriate care, discharge planning, and cost-effective utilization across the treatment continuum. You will lead reviews of admissions, stays, discharges, and appeals, acting as a liaison between payers and clinical care teams.

The role requires strong clinical judgement, knowledge of ASAM dimensions, and adherence to confidentiality.

Qualifications

• Master’s Degree of Social Sciences or commensurate experience required.
• Active substance abuse or mental health licensure in the state where treatment services are rendered.
• 1+ year of experience in relevant field required.
• Ability to exercise discretion and maintain confidentiality.

Responsibilities

• Apply utilization criteria to monitor admissions and levels of care.
• Communicate with third-party payers for initial and concurrent clinical review.
• Review patient charts to ensure continued medical necessity.
• Document actions and information shared with care team or payer.
• Discuss with clinical care team when patient no longer meets medical necessity criteria.
• Refer to management any case surpassing LOS, cost, or utilization expectations.
• Prepare appeals on denied cases when appropriate.
• Interact with patients, families, payers, and staff clearly and concisely.

Skills

Critical thinking

Communication

Attention to detail

Microsoft Office

Organizational skills

Interpersonal skills

Education

Master’s Degree in Social Sciences

Job description

Northpoint Recovery Holdings, LLC is seeking a licensed Utilization Review Specialist to ensure clinically appropriate care, discharge planning, and cost-effective utilization across the treatment continuum. You will lead reviews of admissions, stays, discharges, and appeals, acting as a liaison between payers and clinical care teams.

The role requires strong clinical judgement, knowledge of ASAM dimensions, and adherence to confidentiality.